Materiały źródłowe

• #1 Rheumatic fever – Hancock Health

  https://www.hancockhealth.org/mayo-health-library/rheumatic-fever/

  Rheumatic fever symptoms usually start about 2 to 4 weeks after a strep throat infection. Symptoms are due to swelling, called inflammation, in the heart, joints, skin or central nervous system. There may be few symptoms or several. Symptoms can come and go or change while a person is sick with rheumatic fever. […] Rheumatic fever symptoms can include: Fever. Joint pain or swelling most often the knees, ankles, elbows and wrists. Joints may feel hot or tender. Pain in one joint that travels to another joint. Chest pain. Fatigue. Small, painless bumps beneath the skin. Flat or slightly raised, painless rash with a ragged edge. […] Some people with rheumatic fever develop a condition called Sydenham chorea. Symptoms of this condition include: Jerky, uncontrollable body movements, most often in the hands, feet and face. Outbursts of crying or inappropriate laughing.

• #2 Rheumatic Fever: Causes, Symptoms (Rash) & Treatment

  https://my.clevelandclinic.org/health/diseases/16616-rheumatic-fever

  One common symptom of rheumatic fever is a rash. The rash may be flat and red with irregular edges. Other common rheumatic fever symptoms include: Swollen, tender and red joints (arthritis) especially your childs knees, ankles and elbows that may move around from day to day. Jerky movements your child cant control in their hands, feet or other body parts (chorea). Small bumps (nodules) under your childs skin. Chest pain or abnormal heartbeat. Feeling overly tired all the time (fatigue). Fever. Unexplained or ongoing headaches, especially if your child has never complained of head pain before. Muscle aches. Swollen, red tonsils. […] Rheumatic fever usually develops two to three weeks after an untreated strep throat or scarlet fever infection. […] Rheumatic fever can come back or become a serious problem. In some cases, rheumatic fever can lead to serious or even life-threatening complications. Your child may need regular checkups to protect their health long-term.

• #3 Rheumatic fever

  https://www.nhs.uk/conditions/rheumatic-fever/

  Symptoms of rheumatic fever usually appear 1 to 5 weeks after you’ve had a bacterial throat infection. […] They can include: a high temperature, pain and swelling in your joints (arthritis), usually ankles, knees, wrists or elbows your joints may also look red, although this may be less obvious on brown or black skin, pain in your chest, breathlessness and a fast heart rate, jerky, uncontrollable movements in your hands, feet and face, tiny bumps under your skin, pale-red patches on your arms and tummy (abdomen) these may be harder to see on brown or black skin. […] Most people usually make a full recovery by about 3 months. But it can sometimes take longer to get better. […] If you’ve had rheumatic fever once, it’s more likely to come back, so make sure to get sore throats treated early. […] It can also cause permanent damage to your heart (rheumatic heart disease). This can take years to show up, so you may need regular check-ups and further treatment when you’re older.

• #4 Rheumatic fever: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/003940.htm

  Rheumatic fever mainly affects children ages 5 to 15 who have had strep throat or scarlet fever. If it occurs, it develops about 14 to 28 days after these illnesses. […] Symptoms can affect many systems in the body. General symptoms may include: Fever, Nosebleeds, Pain in the abdomen, Heart problems, which may have no symptoms, or may lead to shortness of breath and chest pain. […] Symptoms in the joints can: Cause pain, swelling, redness, and warmth, Mainly occur in the knees, elbows, ankles, and wrists, Change or move from one joint to another. […] A condition that affects the brain and nervous system, called Sydenham chorea, can also occur. Symptoms of this condition are: Loss of control of emotions, with bouts of unusual crying or laughing, Quick, jerky movements that mainly affect the face, feet, and hands.

• #5 Rheumatic Fever – UF Health

  https://ufhealth.org/conditions-and-treatments/rheumatic-fever

  Rheumatic fever mainly affects children ages 5 to 15 who have had strep throat or scarlet fever. If it occurs, it develops about 14 to 28 days after these illnesses. […] Symptoms can affect many systems in the body. General symptoms may include: Fever, Nosebleeds, Pain in the abdomen, Heart problems, which may have no symptoms, or may lead to shortness of breath and chest pain. […] Symptoms in the joints can: Cause pain, swelling, redness, and warmth, Mainly occur in the knees, elbows, ankles, and wrists, Change or move from one joint to another. […] A condition that affects the brain and nervous system, called Sydenham chorea, can also occur. Symptoms of this condition are: Loss of control of emotions, with bouts of unusual crying or laughing, Quick, jerky movements that mainly affect the face, feet, and hands.

• #6 Acute Rheumatic Fever – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK594238/

  Acute rheumatic fever (ARF) is an abnormal immunologic response to group A Streptococcus (GAS) infections, most commonly tonsillopharyngitis. ARF affects multiple organ systems and may have cardiac, neurologic, musculoskeletal, or dermatological manifestations. While ARF most commonly occurs in children, it can affect people of any age. The recurrence rate of ARF is very high, particularly in patients with limited access to healthcare. Severe or recurrent bouts of ARF can result in significant morbidity and mortality and the development of rheumatic heart disease (RHD). […] Prompt diagnosis and treatment of ARF are essential in preventing complications and consequences of the disease. […] The pathophysiology of ARF is characterized by an aberrant immune response to GAS infection triggered by molecular mimicry between GAS antigens and self-antigens. This immune response typically manifests 2 to 4 weeks after the initial GAS infection and may lead to the development of carditis, valvulitis, Sydenham chorea, subcutaneous nodules, erythema marginatum, and polyarthritis that is usually migratory. The severity and distribution of these manifestations vary significantly between individuals, making the diagnosis of ARF challenging. Early recognition of ARF using the modified Jones criteria is essential in treating acute infection and preventing complications. A major long-term consequence is RHD, which carries significant morbidity and mortality.

• #7 Acute Rheumatic Fever – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK594238/

  The clinical manifestations of ARF vary drastically; some infections may be subclinical, and a diagnosis of ARF is not made until a patient is diagnosed with cardiac disease. Most patients with ARF display constitutional symptoms, including fevers, chills, and fatigue. […] Carditis is the most serious presentation of ARF. The most common physical examination findings of carditis are tachycardia or the presence of a new murmur. Carditis occurs in 50% to 80% of patients with ARF and usually presents as pancarditis within 2 to 3 weeks of GAS infection involving the pericardium, epicardium, myocardium, and endocardium. […] The transition from ARF to RHD occurs when valvular lesions evolve over 10 to 20 years or during multiple episodes of ARF. RHD is the most common cause of acquired valvular disease, affecting the mitral valve most frequently. Due to severe pancarditis or valvulopathy, cardiomyopathy and heart failure can occur, even during ARF.

• #8 About Rheumatic Fever | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/about/rheumatic-fever.html

  Rheumatic fever can develop about 1 to 5 weeks after a group A strep infection. […] Symptoms can include: Arthritis (painful, tender joints), Chorea (jerky, uncontrollable body movements), Fatigue (tiredness), Fever. […] Symptoms of rheumatic fever can also include symptoms of congestive heart failure: Chest pain, Fast heartbeat, Shortness of breath. […] If rheumatic fever is not treated promptly, rheumatic heart disease may occur. Rheumatic heart disease weakens the valves between the chambers of the heart. Severe rheumatic heart disease can require heart surgery and result in death.

• #9 Rheumatic Fever Diagnosis, Symptoms, Treatment & Causes

  https://www.emedicinehealth.com/rheumatic_fever/article_em.htm

  Rheumatic fever is a complication of a streptococcal pharyngitis infection (strep throat) that can cause damage to the heart, joints, brain, and skin. […] After strep throat, some individuals can develop a second illness one to five weeks later with fever, joint pains, rash, and sometimes brain and heart problems. […] The main symptom of rheumatic fever is a fever one to five weeks after strep throat. The fever is usually under 102 F and improves with acetaminophen (Tylenol) or ibuprofen (Advil). […] Acute rheumatic fever is often accompanied by joint swelling and pain (arthritis). Arthritis occurs in 75% of first attacks of rheumatic fever. […] Heart problems (carditis), occur in about half the cases of rheumatic fever. The most common and important heart problem due to rheumatic fever is inflammation and eventually destruction of heart valves.

• #10 Rheumatic Fever

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3232519/

  Arthritis is the most common manifestation, present in 60-80% of patients. It usually affects the peripheral large joints; small joints and axial skeleton are rarely involved. Knees, ankles, elbows and wrists are the most frequently affected. In addition to arthralgia, the joints are red, warm and swollen. Arthritis is characteristically asymmetrical, migratory, and very painful, although some patients may present mild joint complaints. It usually resolves spontaneously at the most in 2 or 3 weeks. […] Acute carditis was present in 50% of patients in a large recent series. It is a pancarditis, but valvular involvement is the rule. The commonest involved valve is the mitral, frequently associated with aortic valve involvement. Right-sided heart valves are rarely affected. […] The clinical picture includes high pulse rate, congestive heart failure, arrhythmias and pericardial friction rubs. On the first attack, valvulitis is suspected in the presence of a new apical systolic murmur of mitral regurgitation and/or a basal diastolic murmur of aortic regurgitation. Cardiomegaly is noted on X-Ray and on echocardiogram.

• #11 Information on Rheumatic Fever & Post-Streptococcal Reactive Arthritis Disease — Dr Jeffrey Chaitow

  https://www.jeffchaitowpractice.com.au/rheumatic-fever-and-post-streptococcal-reactive-arthritis

  Rheumatic fever usually presents a combination of symptoms that may be unique in each patient. It follows streptococcal pharyngitis or tonsillitis not treated with antibiotics. Pharyngitis or tonsillitis can be recognized by fever, sore throat, headache, red palate and tonsils with purulent secretions and enlarged and painful neck lymph nodes. […] After the acute infection has resolved, there is an asymptomatic period of 2-3 weeks. Then the child may present with fever and the signs of the disease described below. […] Arthritis most commonly affects several large joints at the same time or may move from one joint to another affecting one or two at a time (knees, elbows, ankles or shoulders). It is called „migratory and transient arthritis”. Arthritis affecting hands and cervical spine is less common. Joint pain may be severe even when swelling is absent. Note that pain usually subsides promptly after administration of anti-inflammatory drugs. Aspirin is the most used anti-inflammatory drug.

• #12 Rheumatic fever – Hancock Health

  https://www.hancockhealth.org/mayo-health-library/rheumatic-fever/

  Joint and tissue swelling caused by rheumatic fever can last a few weeks to several months. For some people, the swelling causes long-term complications. […] One complication of rheumatic fever is long-lasting heart damage. This is called rheumatic heart disease. Rheumatic heart disease usually occurs years to decades after the original illness. […] However, severe rheumatic fever can start to damage the heart valves while a child still has symptoms of the infection. The valve between the two left chambers of the heart is most commonly affected. This valve is called the mitral valve. But other heart valves also may be affected. […] Rheumatic fever can cause these types of heart damage: Narrowing of a heart valve, also called valve stenosis. The valve flaps become thick or stiff and possibly connect together. This decreases blood flow through the valve. Backward flow of blood across a heart valve. This is called valve regurgitation. It occurs when the valve flaps don’t close properly. Damage to heart muscle. Tissue swelling from rheumatic fever can weaken the heart muscle. This damage may affect the heart’s ability to pump. Heart failure. Heart damage from rheumatic fever also may cause heart failure later in life. Irregular heartbeats. Damage to the heart valves or other areas of the heart can lead to irregular and very fast heartbeats. This also is known as atrial fibrillation (AFib).

• #13 Clinical Guidance for Acute Rheumatic Fever | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/acute-rheumatic-fever.html

  Acute rheumatic fever is a delayed sequela of some group A streptococcal infections. […] It affects many organ systems and has a varied clinical presentation. […] One manifestation, carditis, may result in long-term disability or death. […] Carditis is the major cardiac manifestation of acute rheumatic fever. It occurs in 50% to 70% of first episodes and is associated with valvulitis. […] Chorea, also called Sydenham’s chorea or St. Vitus dance, is the major central nervous system manifestation. Chorea often appears after the other manifestations of acute rheumatic fever. It also can appear as the only manifestation of acute rheumatic fever. […] Subcutaneous nodules and erythema marginatum are the two major skin manifestations. Nodules are most commonly present in patients with carditis.

• #14 Information on Rheumatic Fever & Post-Streptococcal Reactive Arthritis Disease — Dr Jeffrey Chaitow

  https://www.jeffchaitowpractice.com.au/rheumatic-fever-and-post-streptococcal-reactive-arthritis

  Chorea is a movement disorder resulting from inflammation of parts of the brain controlling the coordination of movements. It affects 10-30% of patients with rheumatic fever. Unlike arthritis and carditis, chorea appears later during disease course, from 1 to 6 months after the throat infection. Early signs are poor handwriting in school age patients, difficulties with dressing and self-care, or even with walking and feeding, due to trembling involuntary movements. Movements may be suppressed voluntarily for short periods, may disappear during sleep or be exacerbated by stress or fatigue. […] Less common manifestations of rheumatic fever are the skin rashes called „erythema marginatum”, which look like red rings, and „subcutaneous nodules” that are painless mobile grain nodules with normal overlying skin colour, usually seen over the joints. These signs are present in less than 5% of cases and may be overlooked because of their subtle and transient appearance. These signs are not isolated, but they occur together with myocarditis (inflammation of the heart muscle). There are other complaints that may be first noticed by parents such as fever, fatigue, loss of appetite, pallor, abdominal pain and nosebleeds, which may occur in early stages of the disease.

• #15 Rheumatic fever, erythema marginatum

  https://dermnetnz.org/topics/rheumatic-fever

  Symptoms of ARF generally develop several weeks after an episode of streptococcal pharyngitis. However, many patients do not recall having a sore throat. Non-specific symptoms include: Fever, Abdominal pain, Muscle aches. ARF causes a variety of more specific clinical features: Polyarthritis (multiple inflamed joints) Most often ankles, knees, elbows, wrists. Arthritis can migrate from one joint to another. Carditis (inflammation of the heart) This involves the heart valves, heart muscle, and membrane surrounding the heart. Sydenham chorea This is a disorder of the nervous system characterised by personality changes, muscle weakness, and involuntary movements. Skin signs in ARF may include: Erythema marginatum rheumaticum This is a characteristic type of annular erythema that occurs in about 10% of first attacks of ARF in children; it is very rare in adults. The rash can be difficult to detect in dark-skinned people. When present, it is found on the trunk and upper arms and legs, but almost never on the face, palms or soles. The rash appears as pink or red macules (flat spots) or papules (small lumps), which spread outwards in a circular shape. As the lesions advance, the edges become raised and red, and the centre clears. The lesions are not itchy or painful, and sometimes go unnoticed by the patient. The lesions can fade and reappear within hours, reappearing in hot conditions. Erythema marginatum may persist intermittently for weeks to months, even after successful treatment of ARF.

• #16 Rheumatic fever: Causes, symptoms, and treatment

  https://www.medicalnewstoday.com/articles/176648

  Rheumatic fever is an inflammatory reaction. It can develop as a complication of a Group A streptococcal infection, such as strep throat or scarlet fever. Rheumatic fever occurs when the infection has been untreated or undertreated. […] Not everyone who has a streptococcal infection will develop rheumatic fever (RF), but if RF does develop, symptoms normally appear 2 to 4 weeks after infection. […] RF can have long-term complications, the most common being rheumatic heart disease (RHD) which develops in 30 to 45 percent of those with RF. […] Signs and symptoms generally develop 2 to 4 weeks after a streptococcal infection. […] Some individuals will experience just one or two of the following symptoms, but others may experience most of them: fatigue, rapid heart rate, decreased ability to exercise, joint pain and swelling, fever, splotchy rash, uncontrollable twitching and movements.

• #17 Pediatric Rheumatic Fever – Conditions and Treatments | Children’s National Hospital

  https://www.childrensnational.org/get-care/health-library/rheumatic-fever

  Rheumatic fever is a complex disease that affects the joints, skin, heart, blood vessels and brain. […] Symptoms may include joint inflammation, small, hard bumps under the skin, jerky movements, a rash and fever. […] The symptoms usually start about one to five weeks after a child has been infected with strep bacteria. Each child’s symptoms may vary. Common symptoms can include: Inflammation in joints such as the knees or ankles that causes swelling, soreness, and redness; Small, painless, hard bumps (nodules) under the skin, often over bony areas; Unusual jerky movements, most often of the face and hands. This is often noted by a change in a child’s handwriting; Red rash with odd edges on the torso, arms or legs; Fever; Weight loss; Lack of energy (fatigue); Stomach pains. […] If the illness severely attacks a child’s heart, this may damage heart valves and cause heart disease.

• #18 Rheumatic fever

  https://info.health.nz/conditions-treatments/infectious-diseases/rheumatic-fever

  Rheumatic fever usually starts 1 to 5 weeks after tamariki and rangatahi have had strep throat or a strep skin infection. […] If you or your tamaiti have any of the following symptoms, take them to your healthcare provider as soon as possible. […] Sore joints. These are the most common symptom of rheumatic fever. This includes the hip, knees, elbows, ankles and wrists. Different joints may be sore on different days. Sore joints may cause a limp or difficulty walking due to pain. […] Joints that are red, swollen and feel hot. […] Shortness of breath you may feel short of breath more easily than usual when you are active. […] A rash. […] Small painless lumps under the skin over the elbows, wrists, knees, ankles or spine. […] Unusual jerky movements of your hands, feet, tongue and face. This can look like fidgeting or being unable to sit still, and can affect your handwriting. The movements stop during sleep. […] Over time, most of these symptoms will go away. But heart damage can be permanent. […] Other less common symptoms can include: tummy pains, weight loss, extreme tiredness, an ongoing fever at or greater than 38 C that lasts a few days.

• #19 Rheumatic Fever: Causes, Treatment, and Prevention

  https://www.healthline.com/health/rheumatic-fever

  Rheumatic fever is caused by a reaction to the bacterium that causes strep throat. […] A wide variety of symptoms are associated with rheumatic fever. A person with the illness could experience a few, some, or most of the following symptoms. Symptoms usually appear two to four weeks after your child has a strep infection. […] Common symptoms of rheumatic fever include: small, painless nodules under the skin, chest pain, rapid fluttering or pounding chest palpitations, lethargy or fatigue, nosebleeds, stomach pain, painful or sore joints in the wrists, elbows, knees, and ankles, pain in one joint that moves to another joint, red, hot, swollen joints, shortness of breath, fever, sweating, vomiting, a flat, slightly raised, ragged rash, jerky, uncontrollable movements of the hands, feet, and face, a decrease in attention span, outbursts of crying or inappropriate laughter.

• #20 Rheumatic fever | healthdirect

  https://www.healthdirect.gov.au/rheumatic-fever

  Rheumatic fever symptoms usually appear 2 to 6 weeks after a Strep A infection. […] Symptoms of rheumatic fever can vary between people. They can range from very mild to severe and may include: fever, painful or swollen joints, jerky movements of the hands, legs, tongue and face, chest pain, a rash on your chest, arms or legs (although this is rare), lumps on your elbows, wrists, knees, ankles and spine (this is also rare), feeling tired and muscles aches. […] If your doctor thinks you have rheumatic fever, you will usually be treated in hospital. […] Long-term treatment includes: regular, long-term antibiotics, prompt treatment of sore throats and skin sores, stopping the development or progression of rheumatic heart disease. […] The main complication of rheumatic fever is rheumatic heart disease (RHD). […] Treatment with antibiotics can help stop you from developing advanced RHD or needing heart surgery.

• #21 Rheumatic Fever – Children’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/children-s-health-issues/bacterial-infections-in-infants-and-children/rheumatic-fever

  Rheumatic fever is inflammation of the joints, heart, skin, and nervous system, resulting from a complication of untreated streptococcal infection of the throat. […] Symptoms of rheumatic fever vary greatly, depending on which parts of the body become inflamed. Typically, symptoms begin 2 to 3 weeks after the disappearance of throat symptoms. The most common symptoms of rheumatic fever are joint pain, fever, chest pain or palpitations caused by heart inflammation (carditis), jerky, uncontrollable movements (Sydenham chorea), rash (erythema marginatum), and small bumps (nodules) under the skin. […] Joint pain and fever are the most common first symptoms. One or several joints suddenly become painful and feel tender when touched. They may also be warm, swollen, and red (arthritis). Joints may be stiff and may contain fluid. Ankles, knees, elbows, and wrists are usually affected.

• #22 Rheumatic Fever – Children’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/children-s-health-issues/bacterial-infections-in-infants-and-children/rheumatic-fever

  Some children with heart inflammation have no symptoms, and the inflammation is recognized years later when heart damage is discovered. […] Heart inflammation disappears gradually, usually within 5 months. However, it may permanently damage the heart valves, resulting in rheumatic heart disease. […] Rheumatic fever and some of the problems it causes, such as inflammation of the heart and Sydenham chorea, can return. Episodes of Sydenham chorea usually last several months and resolve completely in most people, but the disorder returns in about one third of people. Joint problems (such as pain and swelling) are not permanent, but the heart inflammation can be permanent and severe, especially if streptococcal infections return and are not treated.

• #23 Rheumatic Fever Diagnosis, Symptoms, Treatment & Causes

  https://www.emedicinehealth.com/rheumatic_fever/article_em.htm

  Sydenham’s chorea is another sign of rheumatic fever. […] Skin problems can occur as a result of rheumatic fever in about 2% of people. […] Rheumatic fever will go resolve spontaneously within 12 weeks even if is not treated. […] The main complication of rheumatic fever is rheumatic heart disease (RHD). […] If the heart is severely affected, the patient may go on to develop rheumatic heart disease. […] If not treated, destruction and scarring of the valves can lead to heart failure. […] Long term, patients who have had one bout of rheumatic fever are at higher risk to develop rheumatic fever with future strep infections.

• #24 Rheumatic fever – Wikipedia

  https://en.wikipedia.org/wiki/Rheumatic_fever

  The rate of development of rheumatic fever in individuals with untreated strep infection is estimated to be 3%. The incidence of recurrence with a subsequent untreated infection is substantially greater (about 50%). The recurrence of rheumatic fever is relatively common in the absence of maintenance of low dose antibiotics, especially during the first three to five years after the first episode. Recurrent bouts of rheumatic fever can lead to valvular heart disease. Heart complications may be long-term and severe, particularly if valves are involved.

• #24 Rheumatic fever – Wikipedia

  https://en.wikipedia.org/wiki/Rheumatic_fever

  Rheumatic fever is an inflammatory disease that can involve the heart, joints, skin, and brain. The disease typically develops two to four weeks after a streptococcal throat infection. Signs and symptoms include fever, multiple painful joints, involuntary muscle movements, and occasionally a characteristic non-itchy rash known as erythema marginatum. The heart is involved in about half of the cases. Damage to the heart valves, known as rheumatic heart disease (RHD), usually occurs after repeated attacks but can sometimes occur after one. The damaged valves may result in heart failure, atrial fibrillation and infection of the valves. […] Symptoms include: fever, painful joints with those joints affected changing with time, involuntary muscle movements, and occasionally a characteristic non-itchy rash known as erythema marginatum. The heart is involved in about half of the cases. Damage to the heart valves usually occurs only after several attacks but may occasionally occur after a single case of RF. The damaged valves may result in heart failure and also increase the risk of atrial fibrillation and infection of the valves.

• #25 Pediatric Rheumatic Fever – Conditions and Treatments | Children’s National Hospital

  https://www.childrensnational.org/get-care/health-library/rheumatic-fever

  Many cases of rheumatic fever may be prevented by quickly and correctly treating strep throat with antibiotics. […] Having rheumatic fever increases your child’s chances of having the disease again. This is at highest risk during the first three years. The chance of having the disease again lessens with age and time.

• #26 Acute Rheumatic Fever – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK594238/

  The usual course of ARF is about 3 months, and recurrence rates approximate 65%. Recurrence increases the risk of progression to RHD and heart failure. Risk factors contributing to recurrence include poor adherence to prophylaxis, shorter intervals between episodes of ARF, younger age, and the presence of carditis. […] Cardiac involvement is the most critical prognosticating factor in ARF. Patients with carditis are at the highest risk for developing RHD, the most common cause of morbidity and mortality in patients with ARF. The long-term prognosis of ARF has significantly improved over the last century in developed areas, with enhanced therapy for GAS eradication, long-term secondary prophylaxis, and improved living conditions. Despite this, patients in resource-poor areas commonly present with late-stage RHD.

• #27 Frequently Asked Questions | Te Whatu Ora – Te Tai Tokerau

  https://www.northlanddhb.org.nz/your-health/health-resources/rheumatic-fever-2/frequently-asked-questions/

  Most of the acute symptoms, such as sore or swollen joints (knees, elbows, ankles and wrists), skin rash, a fever, stomach pain and jerky movements, go away in time. However, damage to the heart valves – rheumatic heart disease – can be permanent. […] Rheumatic fever can occur again if your child has another infection with the Strep A bug which goes untreated. The best way to stop your child having another attack of rheumatic fever is to make sure they have regular Penicillin injections – on time. […] Each attack of rheumatic fever has the potential to damage the heart. But with proper care and regular Penicillin injections, most children with rheumatic fever lead a normal life.

• #28 Rheumatic Fever and Rheumatic Heart Disease | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/rheumatic-fever-and-rheumatic-heart-disease

  Rheumatic fever can cause: […] Carditis: inflammation of the heart muscle and heart tissue. Carditis can cause a rapid heart rate, fatigue, shortness of breath and exercise intolerance. This is the most serious of the symptoms and may have long-term effects on health. Carditis occurs in approximately 50 percent of those who have rheumatic fever […] For children who do develop severe carditis, the inflammation leads to scarring and permanent damage to the heart, and particularly to the heart valves. The mitral valve, which controls the flow of blood between the upper left chamber and the lower left chamber of the heart, is most often damaged. The aortic valve, which sends the blood from the lower left chamber out to the body, is the next most commonly affected heart valve. Leakage of the heart valves is the most common finding. […] In later years, blockage of the mitral valve can occur due to scarring. If either valve starts to leak severely, surgery to repair or replace it may be necessary. Usually this isnt necessary before adulthood, but in severe cases, surgery during youth is necessary.

• #29 What Are the Long-Term Side Effects of Rheumatic Fever? Complications

  https://www.medicinenet.com/long-term_side_effects_of_rheumatic_fever/article.htm

  If not promptly treated, rheumatic fever can have long-term side effects such as rheumatic heart disease, which weakens the valves between the hearts chambers. […] The majority of rheumatic fever (RF) symptoms go away after a few weeks or months, but recurrence and certain complications are common. Usually, heart and joint ailments are long-term consequences of RF. […] Rheumatic heart disease (RHD) is one of the most common complications of RF. […] With the first attack of RF, between 40 and 60 percent of people develop heart valve inflammation, which frequently results in permanent scarring of the heart valves. […] Heart valve damage can appear even 10 to 30 years after the initial infection with the following complications: Valve stenosis (narrowing of the valve), Ruptured heart valve (medical emergency that may need surgery to replace or repair the heart valve), Atrial fibrillation (irregular heartbeat), Endocarditis (inflammation of the inner lining of the heart), Heart failure due to inflammation of the heart muscle, Arrhythmias (abnormal heart rhythms), Pericarditis (inflammation of the sac surrounding the heart), Chest pain or angina.

• #30 What Are the Long-Term Side Effects of Rheumatic Fever? Complications

  https://www.medicinenet.com/long-term_side_effects_of_rheumatic_fever/article.htm

  The long-term effects of RF can be disabling if your child experiences a severe case. Some of the side effects of RF may not manifest themselves for years. […] Inflammation caused by acute rheumatic fever (RF) can damage every part of the heart, including the outer sac (the pericardium), inner lining (the endocardium), and valves. Rheumatic heart disease (RHD) refers to a group of both short-term (acute) and long-term (chronic) heart disorders that can develop because of RF. […] RHD is a condition in which RF may cause permanent damage to the heart valves. […] Heart valve problems, which are frequently the result of RHD, can cause the following symptoms: Chest pain, Excessive fatigue, Heart palpitations (heart flutters), A thumping sensation in the chest, Shortness of breath, Swollen ankles, wrists, or stomach. […] If RF causes heart damage in childhood or young adulthood, daily antibiotics may be required until 25 or 30 years of age to help prevent RF recurrence and the development of infective bacterial endocarditis (an infection of the heart valves or lining).

• #31 Rheumatic heart disease | Heart and Stroke Foundation

  https://www.heartandstroke.ca/heart-disease/conditions/rheumatic-heart-disease

  The symptoms of heart valve problems which are often the result of rheumatic heart disease can include: chest discomfort or pain, irregular or rapid heartbeats (heart palpitations), shortness of breath, fatigue or weakness, light-headedness, dizziness or near fainting, swelling of the stomach, feet or ankles. […] If you have one or more of these symptoms, see your doctor. Get immediate medical help if you experience chest pain, fainting or difficulty breathing.

• #32 Rheumatic fever long-term effects explained

  https://www.medicalnewstoday.com/articles/rheumatic-fever-long-term-effects

  Rheumatic fever symptoms include inflammation of the heart, joints, brain, and skin. This happens because the immune system mistakes these areas for an infection and attacks them. […] Generally, rheumatic fever symptoms include: fever, arthritis or tender joints, especially in the knees, ankles, elbows, and wrists, chest pain, shortness of breath, fatigue, jerky body movements, heart murmur, enlarged heart, fluid surrounding the heart. […] The long-term effects of rheumatic fever mainly affect the heart and joints. When a person develops a heart condition after rheumatic fever, this is known as RHD, a serious cardiovascular disease. RHD can increase a person’s risk of stroke, pulmonary hypertension, and heart failure. […] Rheumatic fever can also cause other long-term conditions, including Jaccoud arthropathy, which tends to affect the joints in the hands and feet.

• #33 Rheumatic Fever | Causes, Symptoms and Treatment

  https://patient.info/infections/rheumatic-fever-leaflet

  The main long-term problem is with the heart. About a third of people who have had rheumatic fever will get long-term problems with their heart. This is then called rheumatic heart disease. It can cause permanent damage to the heart tissue and can require lifelong medication or even surgery to the heart valves many years later.

• #34 Acute Rheumatic Fever: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/236582-treatment

  Carditis causes the most severe clinical manifestation because heart valves can be permanently damaged. The disorder also can involve the pericardium, myocardium, and the free borders of valve cusps. Chronic valvular disease may develop even in patients who initially recovered without signs of valvular damage. Death or total disability may occur years after the initial presentation of carditis.

• #35 Rheumatic fever – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rheumatic-fever/diagnosis-treatment/drc-20354594

  There’s no single test for rheumatic fever. Diagnosis of rheumatic fever is based on medical history, a physical exam and certain test results. […] The goals of treatment for rheumatic fever are to: Treat the infection. Ease symptoms. Control swelling, called inflammation. Prevent the condition from returning. […] It’s important to have regular health checkups after having rheumatic fever. Heart damage from rheumatic fever might not show up for many years even decades. Always tell your healthcare provider about any history of rheumatic fever. […] A healthcare provider might recommend bed rest for someone with rheumatic fever. There may be activity restrictions until symptoms improve.

• #36

  https://www.amerikanhastanesi.org/mayo-clinic-care-network/mayo-clinic-health-information-library/diseases-conditions/rheumatic-fever

  Rheumatic fever can cause these types of heart damage: Narrowing of a heart valve, also called valve stenosis. The valve flaps become thick or stiff and possibly connect together. This decreases blood flow through the valve. Backward flow of blood across a heart valve. This is called valve regurgitation. It occurs when the valve flaps don’t close properly. Damage to heart muscle. Tissue swelling from rheumatic fever can weaken the heart muscle. This damage may affect the heart’s ability to pump. Heart failure. Heart damage from rheumatic fever also may cause heart failure later in life. Irregular heartbeats. Damage to the heart valves or other areas of the heart can lead to irregular and very fast heartbeats. This also is known as atrial fibrillation (AFib). […] It’s important to have regular health checkups after having rheumatic fever. Heart damage from rheumatic fever might not show up for many years even decades. Always tell your healthcare provider about any history of rheumatic fever.

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